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Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting

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journal contribution
posted on 06.06.2016, 09:58 by Sarah L. Tennant, Jonathan James, Eleanor J. Cornford, Yan Chen, Helen C. Burrell, Lisa J. Hamilton, Constantine Girio-Fragoulakis
Aim. To assess the diagnostic accuracy of Contrast Enhanced Spectral Mammography (CESM), and gauge its “added value” in the symptomatic setting. Methods. At our institution, women aged 35-70 years with a suspicious or malignant clinical abnormality are offered CESM instead of standard Full-Field Digital Mammography (FFDM) as an initial imaging test. CESM is also offered to younger women whose ultrasound is suspicious, or who have biopsy-proven malignancy. It is occasionally used as an alternative to breast MRI following multi-disciplinary team discussion. We performed a retrospective multi-reader review of 100 consecutive CESM examinations. Anonymised Low Energy (LE) images were reviewed and given a score for malignancy. At least 3 weeks later, the entire examination (LE and recombined images) was reviewed. Pathology data was obtained for all cases. Differences in performance were assessed using receiver operative characteristic (ROC) analysis. Sensitivity, specificity and lesion size (vs MRI or histopathology) differences were calculated. Results. 73% cases were malignant at final histology, 27% were benign following standard triple assessment. ROC analysis showed improved overall performance of CESM over LE alone, with area under the curve of 93% vs 83% (p<0.025). CESM showed increased sensitivity (95% vs 84, p<0.025) and specificity (81% vs 63%, p<0.025) compared to LE alone, with all 5 readers showing improved accuracy. Tumour size estimation at CESM was significantly more accurate than LE alone, the latter tending to undersize lesions. In 75% of cases CESM was deemed a useful or significant aid to diagnosis. Conclusion. CESM provides immediately available, clinically useful information in the symptomatic clinic in patients with suspicious palpable abnormalities. Radiologist sensitivity, specificity and size accuracy for breast cancer detection and staging are all improved using CESM as the primary mammographic investigation.

History

School

  • Science

Department

  • Computer Science

Published in

Clinical Radiology

Citation

TENNANT, S. ... et al., 2016. Contrast-enhanced spectral mammography improves diagnostic accuracy in the symptomatic setting. Clinical Radiology, 71 (11), pp. 1148-1155.

Publisher

© The Royal College of Radiologists. Published by Elsevier

Version

AM (Accepted Manuscript)

Publisher statement

This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/

Publication date

2016

Notes

This paper was accepted for publication in the journal Clinical Radiology and the definitive published version is available at http://dx.doi.org/10.1016/j.crad.2016.05.009

ISSN

1365-229X

eISSN

0009-9260

Language

en

Exports

Loughborough Publications

Exports